OPINION: Why criminalisation and discrimination threaten to derail the fight against HIV

by Sbongile Nkosi | Global Network of People Living with HIV
Tuesday, 2 August 2022 10:56 GMT

ARCHIVE PHOTO: A medical worker helps a woman to draw blood for a HIV test at the free medical camp in Ratodero, Pakistan May 25, 2019. Picture taken May 25, 2019. REUTERS/Akhtar Soomro

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* Any views expressed in this opinion piece are those of the author and not of Thomson Reuters Foundation.

The data is clear. The HIV response is less successful in countries that criminalise same-sex sexual acts, sex work, and drug use

Sbongile Nkosi is the co-executive director at the Global Network of People Living with HIV

Today, advancements in HIV prevention and treatment have given us more ways than ever to prevent new infections and care for those living with HIV.

Countries are moving to roll out new HIV prevention tools, such as PrEP, a daily pill that cuts transmission, and a newer, antiretroviral-based vaginal ring shown to reduce women’s risk of contracting HIV by more than half

We know more than ever that effective, easy-to-use treatment is also one of our best prevention strategies. Decades of research have proven that people who are supported to take their treatment as directed can become virally suppressed, meaning the level of virus in their blood falls to levels so low that it is undetectable.

When someone’s viral load is undetectable, they can no longer transmit the virus.   

But despite these developments, countries continue to criminalise HIV transmission and communities at high risk of the virus — namely those in same-sex relationships, those who choose sex work as their profession and people who use drugs. 

This week, leading scientists, policymakers and activists have convened in Montreal for the International Aids Conference. At the centre of the meeting must be the recognition that criminalisation, stigma and discrimination remain some of the biggest threats to the HIV response. 

Nearly 40 million people are estimated to be living with HIV around the world — they and the communities most affected by this pandemic do not deserve to be treated like criminals..

Ninety-two countries criminalise HIV non-disclosure, exposure and transmission, according to UNAIDS. Civil society reports suggest this number could be as high as 130.

The impact of these laws is clear. 

On average, 12% fewer HIV-positive people in countries like these knew their HIV status, the 2021 research revealed. Nations that criminalise same-sex relationships, sex work or drug use also had rates of viral suppression about 10% lower than countries in which these communities were not treated like criminals. 

Meanwhile, a study published in The Lancet found that  decriminalising  sex work could avert 33-46 % of HIV infections in the next decade.

The data is clear. The HIV response is less successful in countries that criminalise same-sex sexual acts, sex work, and drug use. The core of the Global Aids strategy is targeted, which are on-call on countries to repeal punitive laws/policies that target key populations and instead implement progressive laws that combat stigma, gender-based violence, and any form of discrimination. 

For decades, communities have been instrumental in gathering evidence on stigma and discrimination. Unsurprisingly, today we are at the helm of some of the world’s only global measures to track criminalisation, stigma and discrimination. 

We continue to work in solidarity to challenge the criminalisation of HIV transmission and key populations. 

But advocacy is expensive and organising communities to hold governments accountable costs money. We need increasing resources to continue this work at global and country levels. Our advocacy efforts are often halted or scaled down due to resources. Now more than ever, more investment and funding are needed from global health institutions. 

Governments must acknowledge that punitive laws against key populations perpetuate stigma and undermine health equity. 

Therefore, we need recognition that the HIV response needs to balance the science with the socio-economic barriers. We need more linkages to be recognised between HIV-related stigma and public health outcomes.

Stigma and discrimination should be a priority and no longer be addressed as a by-product of other activities, such as scaling up treatment and retention in care. 

We all know from the HIV response that for us to see the results, two things are important political leadership and solidarity. Therefore, it's time to scale up the efforts to challenge stigma and discrimination.

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